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Rejected Claims at Submission

Paper claims submitted to Health Net Federal Services, LLC (HNFS) are scanned into our optical character recognition (OCR) process. The OCR reads the claim form and turns it into an electronic record. If key elements to the claim are missing, the system will reject the claim and HNFS will issue a letter to the submitting provider explaining the rejection. This letter is mailed to the provider address on the claim form, which may be different from the address HNFS has on file.

The table below provides codes and descriptions of common rejection reasons for manual claims submissions. Refer to your rejection notice for additional information. You can also view our Sample Reject letter to help you locate the rejection codes on your notice.

Reject Code Code Description Resubmission Tip
00 Invalid code (For claims submitted prior to 2/03/2017.) This reject reason was due to a system issue that has now been resolved. Resubmit the claim for processing.
01 Member's DOB is missing or invalid Verify the veteran’s date of birth.
05 Date prior to receipt date Review the rendered date of service.
09 Member not eligible for date of service The patient is not eligible for VCP/PCCC services. If you feel the claim has been rejected in error, validate the authorization to determine if the authorization was sent through direct care VA.
12 Provider not valid at date of service Verify the servicing provider’s status with the VCP/PCCC program.
17 One or more of the diagnosis codes are invalid or missing Verify the diagnosis code(s) for the veteran’s condition is accurate. At least a primary diagnosis code is required.
34 One or more of the CPT procedure codes submitted is invalid or missing Verify the CPT code(s) for the services rendered is accurate.
69 Accident information required when submitted Based on the service(s) rendered, accident information must be included with the claim. Note that in Box 15, the qualifier 444 should only be used to report the date of the first contact for Property and Casualty claims, with Box 11b indicating the Y4 qualifier and claim number.
90 One or more of the modifiers are invalid or missing The proper use of modifiers identifies procedures that are distinct, independent and not overlapping, even if they occur during the same visit. Please refer to the Centers for Medicare and Medicaid Services’ (CMS) NCCI guidelines for proper use of modifiers on claims.
92 Invalid or missing NPI Verify the servicing and billing provider’s NPI typed on the claim.
96 Ordering/prescribing/referring provider missing or incorrect Ensure the ordering provider’s (also known as the presciribing or referring provider) information is accurately documented.
97 Service facility information invalid or missing Ensure the servicing facility’s information is accurately documented.
98 or 99 Invalid provider SSN at any level Verify the servicing provider’s tax ID number is accurately documented.
A1 We cannot process multiple providers on the same claim, please re-bill separately A separate claim must be submitted for services rendered by each provider.
A2 Diagnosis pointer invalid The diagnosis information document is invalid. Ensure the ICD-10 code and description is accurate.
A4 Service line is incomplete or missing, must have at least one complete service line detail submitted Review the service billed and ensure each line item on the claim matches.
A6 Total charges billed does not equal total of service lines billed Verify each line item on the claim to ensure the sum of each line matches the total amount billed.
A8 Auto accident state required Resubmit claim with valid state abbreviation.
RJ The claim(s) submitted was black and white. Only claim forms that are printed in Flint OCR Red, J6983 (or exact match) ink are accepted. Please submit your claims via the electronic clearing house or the correct paper form in accordance with CMS guidelines. All paper claims must be cleanly completed and submitted using the original red and white CMS form. We are unable to accept photocopied forms, as well as those with highlights, italics, bold text, or staples.